Anxiety, Sleep, and Functional Impairment among Clinically Anxious Youth and Healthy Controls
Childhood anxiety disorders are characterized by non-transient excessive fear or worry that often affects various domains of life, including academic performance and social relationships (Albano & Detweiler, 2001; Langley, Bergman, McCracken, & Piacentini, 2004). A particular concern for children with anxiety disorders are sleep disturbances (Alfano, Ginsburg, & Kingery, 2007; Gregory, Eley, O'Connor, Rijsdijk, & Plomin, 2005). Without sufficient sleep, children experience functional impairments such as increased anxiety severity, academic problems, and behavior problems at school or home. Interestingly, the impairments of sleep deprivation are similar to those of anxiety in children (Crabtree & Witcher, 2008; Sadeh, Gruber, & Raviv, 2002). Although sleep problems are common in children with an anxiety disorder, the relationship between sleep difficulties and anxiety disorders in youth has been minimally studied (Alfano & Lewin, 2008). Moreover, whether children with a comorbid anxiety disorder and sleep difficulties experience greater functional impairment than do children with an anxiety disorder alone has not been empirically examined. The current study examined 60 non-depressed clinically anxious youth (ages 7-18) and 30 healthy controls. All participants underwent a diagnostic assessment and completed the parent/child Screen for Child Anxiety Related Emotional Disorders (SCARED), Life Events Scale (LES), Social Responsiveness Scale (SRS), and Family Risk Factor Checklist - Parent (FRFC-P) at baseline. Findings indicate that sleep functioning did not significantly differ between groups when controlling for age. Rather, sleep functioning was significantly related to life event stressors. In contrast, group differences were revealed in social functioning. Notably, greater social functional impairment was best predicted by anxiety symptom severity rather than sleep functioning. Together, these findings lend support to the necessary examination of compounded anxiety symptom severity and sleep functioning in an effort to better understand impairments associated with youth anxiety disorders, particularly social functioning. The results of this investigation can be used to inform the assessment and treatment of youth with anxiety disorders in an effort to minimize the development, maintenance, and impairments of anxiety associated with sleep problems (Alfano & Lewin, 2008).
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